We have with much interest read the article “Human papillomavirus (HPV) vaccine policy and evidence-based medicine: Are they at odds?” by L. Tomljenovic and C.A. Shaw (Citation1).
Although we agree with some of the authors’ statements, for instance that the vaccination would be more helpful in developing countries than in developed countries, the published article leads, in Belgium, to the false interpretation in the lay press and public that cervical cancer is no problem any more in developed countries.
Invasive cervical cancer remains an important issue, even in some industrialized countries. Between January 2007 and December 2011, in our center, which is a public hospital in Brussels, we diagnosed and treated 86 patients with invasive cervical cancer, while we performed 391 cone biopsies for high-grade pre-cancer cervical lesions during the same period. Out of the 86 patients, 63 (73%) had advanced disease (FIGO stage IB2–IVB cervical cancer). Most of these patients (63%) were Caucasian. We prospectively followed up 72% of them until December 2011 (28% were at this time lost to follow-up). Median follow-up time was 26.5 months (range 1–52). At the time of analysis, 17% of the patients had relapsed (at a median follow-up time of 14.5 months), and 23% had died of their cancer (at a median follow-up time of 12.5 months).
These data unfortunately remind us of the dramatically high price to pay once invasive cervical cancer has been diagnosed.
There is no doubt that almost 100% of invasive cervical cancers are HPV-induced. The efficacy of HPV vaccine, in preventing the development of high-grade pre-cancer (CIN 2–3) lesions of the uterine cervix, has been proven. We have good reason to believe that the incidence of cervical cancer will decrease 15 to 20 years after the beginning of massive vaccination campaigns.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Reference
- Tomljenovic L, Shaw CA. Human papillomavirus (HPV) vaccine policy and evidence-based medicine: are they at odds? Ann Med. 2011 Dec 22. [Epub ahead of print]